Management of Severe Eczema

Introduction to Treatment Options

The British Medical Journal recommends that oral prednisone should NOT be used for severe eczema except in rare circumstances as a short-term bridge therapy, and only after all other treatment options have been exhausted 1, 2
Systemic corticosteroids have a limited but definite role in "tiding over" occasional patients with severe atopic eczema, but the decision should never be taken lightly, according to the British Medical Journal 1, 2, 3

The British Medical Journal suggests that oral corticosteroids should NOT be considered for maintenance treatment until all other avenues have been explored 1, 2, 3
Potent or very potent topical corticosteroids, such as clobetasol propionate 0.05%, applied twice daily for up to 2 weeks are recommended as first-line treatment, as per Praxis Medical Insights 4
Liberal and frequent emollient use throughout the day, especially after bathing, is also recommended as first-line treatment, according to Praxis Medical Insights 4
Avoiding irritants, hot showers, and excessive soap use is advised as part of first-line treatment, as per Praxis Medical Insights 4

The British Medical Journal advises against using oral corticosteroids as first-line therapy, ensuring all topical treatments have been optimized first, including checking for treatment adherence 1, 2
The British Medical Journal also advises against using oral corticosteroids for maintenance therapy, as they are only appropriate as a short-term bridge in exceptional circumstances 1, 2, 3
Considering secondary bacterial infection, particularly Staphylococcus aureus, if topical treatments fail, and adding flucloxacillin or erythromycin if penicillin-allergic, is recommended, as per Praxis Medical Insights 4